Postpartum: First 6 Weeks After Childbirth

Topic Overview

What is postpartum?

During the first weeks after giving birth, your body begins to heal and adjust to not
being pregnant. This is called postpartum (or the postpartum period). Your body goes through many changes as you recover. These changes are different for every woman.

The first weeks after childbirth also are a time to bond with your baby and set up a routine for caring for your baby.

Your doctor will want to see you for a checkup 2 to 6 weeks after
delivery. This is a good time to discuss any concerns, including birth
control.

What happens to your body during the postpartum period?

You
likely will feel sore for a few days and very tired for several weeks. It may take 4 to 6 weeks to feel
like yourself again, and possibly longer if you had a cesarean (or C-section) birth.

Over the next few days and weeks, you may have some bleeding and afterpains as your uterus shrinks.

How can you care for yourself?

It is easy to get too tired and overwhelmed during
the first weeks after childbirth. Take it easy on yourself.

Try to sleep when your baby does.

Ask another adult to be with you for a few days after
delivery.

Let family and friends bring you meals or do chores.

Plan for child care if you have other
children.

Plan
small trips to get out of the house. Change can make you feel less
tired.

Drink
extra fluids if you are breast-feeding.

Your doctor will tell you how to care for your body as you recover. Your doctor will tell you when it's okay to exercise, have sex, and use tampons. He or she also will tell you how to manage pain and swelling while your body heals.

How does postpartum affect your emotions?

The first few weeks after your baby is born can be a time of excitement-and of being very tired. You may look at your wondrous little baby and feel
happy. But at the same time, you may feel exhausted from a lack of sleep and your new
responsibilities.

Many women get the "baby blues" during the first few days after
childbirth. The "baby blues" usually peak around the fourth day and then ease
up in less than 2 weeks. If you have the blues for more than a few days,
or if you have thoughts of hurting yourself or your baby, call your doctor
right away. You may have postpartum
depression. This needs to be treated. Support groups and counseling can help.
Sometimes medicine also can help.

What should you know about newborn care?

During your baby's first few weeks, you will spend most of your time feeding, diapering, and comforting your baby. You may feel overwhelmed at times. It's normal to wonder if you know what you are doing, especially if this is your first child. Newborn care gets easier with every day. Soon you may get to know what each cry means and be able to figure out what your baby needs and wants.

At first, babies often sleep during the day and are awake at night. They don't have a pattern or routine. They may make sudden gasps, jerk themselves awake, or look like they have crossed eyes. These are all normal, and they may even make you smile.

You naturally develop an emotional bond with your baby simply by spending time together, being physically close, and responding to his or her cues.

Recovery At Home

During the days and weeks after the delivery of your baby (postpartum period), your body will change as it returns to its nonpregnant condition. As with pregnancy changes, postpartum changes are different for every woman.

Physical changes after childbirth

The changes in your body may include sore muscles and bleeding.

Contractions called
afterpains shrink the uterus for several days after
childbirth. Shrinking of the uterus to its prepregnancy size may take 6 to 8 weeks.

Sore muscles (especially in the arms, neck,
or jaw) are common after childbirth. This is because of the hard work of labor. The soreness should go away in a few days.

Vaginal soreness, including pain, discomfort, and numbness, is common after vaginal birth. Soreness may be worse if you had a perineal tear or episiotomy.

If you had a cesarean (C-section), you may have pain in your lower belly and may need pain medicine for 1 to 2
weeks.

Breast engorgement
is common between the third and fourth days after delivery, when the breasts
begin to fill with milk. This can cause discomfort and swelling. Placing
ice packs on your breasts, taking a hot shower, or using warm compresses may
relieve the discomfort. For more information, see the topic
Breast Engorgement.

Call your doctor if you are concerned about
any of your symptoms. For more information, see When to Call a
Doctor.

Care after vaginal birth

Most women need some time after delivery to return to their normal activities. It's important to focus on your healing and on taking care of your body after delivery.

Use pads instead of tampons for the bloody flow
that may last as long as 2 weeks.

Ease cramps or afterpains with ibuprofen (such as Advil). If the doctor gave you a prescription
medicine for pain, take it as prescribed.

If you have swelling or pain around the opening of your vagina, try using ice. You can put ice or a cold pack on the area for 10 to 20 minutes at a time. Put a thin cloth between the ice and your skin.

Cleanse yourself
with a gentle squeeze of warm water from a bottle instead of wiping with toilet
paper.

Try sitting in a few inches of warm water (sitz bath) 3 times a day and after bowel movements.

Ease the soreness of hemorrhoids and the area between your
vagina and rectum with ice compresses or witch hazel pads.

Coping With Emotions

Having a new baby is exciting. But it also can be exhausting and stressful. It's common to feel a range of emotions at this time.

Tips for
coping during the postpartum period include accepting
help from others, eating well and drinking plenty of fluids, getting rest
whenever you can, limiting visitors, getting some time to yourself, and seeking
the company of other women who have new babies.

Expect changes in your relationship

If you have a partner and this is your first baby, your focus may have shifted from being part of a couple to being parents. That's a common-and wonderful-change. But it can take some time to adjust. You and your partner may not have as much time or energy for each other for a while. But you also will get to know each other in new ways, as parents.

It is common to
have little interest in sex for a while after childbirth. During the time when
your body is recovering and your baby has many needs, you and
your partner will need to be patient with one another. Talking together is a
good way to deal with the changes in your
sexuality after childbirth.

Watch out for depression

"Baby blues" are common for the first 1 to 2
weeks after birth. You may cry or feel sad or irritable for no reason.
If your symptoms
last for more than a few weeks, or if you feel very depressed, ask your doctor
for help. You may have postpartum depression. It can be treated. Support groups and
counseling can help. Sometimes medicine can also help. For more information, see the topic Postpartum Depression.

Get support from others

If you're feeling tired or overwhelmed, talk to your
partner, friends, and family about your feelings. You also might want to:

Go for walks with your baby.

Find a class for new mothers and new babies
that has an exercise time.

Try yoga, meditation, massage, or other ways to cope with stress. For more information, see the topic Stress Management.

Common Problems

Some women have problems-such as constipation, hemorrhoids, and sore breasts-that last for a while after childbirth. Many minor postpartum problems can be managed at home. If you develop problems and your doctor has given you specific instructions to follow, be sure to follow those instructions.

Constipation and hemorrhoids

Home treatment measures are usually all that is needed to relieve mild discomfort from hemorrhoids or constipation.

To prevent or ease symptoms of constipation:

Eat a high-fiber diet with lots of fruits, vegetables, and whole grains.

Drink plenty of fluids, especially water and fruit juices.

Try a stool softener, such as Colace.

Do not strain (push hard) during a bowel movement.

Get more exercise, such as walking, every day.

To treat the itching or pain of hemorrhoids:

Keep the anus clean by wiping carefully after each bowel movement. Gently wipe from the front to the back. Baby wipes or hemorrhoid pads are usually more gentle than toilet paper. If you use toilet paper, use only soft, undyed, unscented toilet paper.

Take warm soaks in a tub or a sitz bath. Warm water can help shrink or soothe hemorrhoids. Add baking soda to the water to relieve itching.

Use cold packs.
You can put ice or a cold pack on the
area for 10 to 20 minutes at a time. Put a thin cloth between the ice and your
skin.

Do not sit for long periods, especially on hard chairs.

Drink plenty of fluids and use stool softeners,
if needed. Don't strain (push hard) during a bowel
movement.

Vaginal and perineal problems

Soreness in the vagina and the area between it and the anus (perineum) is common after delivery. You can ease the pain with home treatment. To reduce pain and heal:

Try using ice. You can put ice or a cold pack on the area for 10 to 20 minutes at a time. Put a thin cloth between the ice and your skin.

Cleanse yourself
with a gentle squeeze of warm water from a bottle instead of wiping with toilet
paper.

Try sitting in a few inches of warm water (sitz bath) 3 times a day and after bowel movements.

Pelvic bone problems

Recovery from pelvic bone problems, such as separated
pubic bones or a fractured tailbone (coccyx), can take
several months. Treatment includes ice, nonsteroidal anti-inflammatory drugs
(NSAIDs), and sometimes physical therapy.

Breast problems

Breast engorgement
is common between the third and fourth days after delivery, when the breasts
begin to fill with milk. This can cause breast discomfort and swelling. Placing
ice packs on your breasts, taking a hot shower, or using warm compresses may
relieve the discomfort. If you aren't breast-feeding, use ice rather
than heat for breast soreness. For more information, see the topic
Breast Engorgement.

For breast problems related to breast-feeding, see the topic Breast-Feeding.

Postpartum Checkup

Your doctor will want to see you for a checkup 2 to 6 weeks after
delivery. This visit allows for your doctor or midwife to check on your recovery from childbirth and see how you are doing emotionally. You may have a pelvic exam to make sure that you are healing well. If you had a C-section, your doctor will check your incision.

Your doctor or midwife will talk with you about birth control and find out how you're doing with breast-feeding. He or she also will ask about your moods and check you for signs of postpartum depression.

This visit is also a good time to talk to your doctor about anything you are concerned or curious about.

Keep a list of questions to bring to your
postpartum visit. Your questions might be about:

Changes in your breasts, such as lumps or
soreness.

When to expect your menstrual period to start
again.

What form of birth control is best for
you.

Weight you have put on during the
pregnancy.

Exercise options.

What foods and drinks are
best for you, especially if you are breast-feeding.

Problems you
might be having with breast-feeding.

When you can have sex. Some
women may want to talk about lubricants for the vagina.

Any
feelings of sadness or restlessness that you are having.

Health and Nutrition

It is easy to get too tired and overwhelmed during the first weeks after childbirth. Take it easy on yourself. Get rest whenever you can, accept help from others, and eat well and drink plenty of fluids.

Getting rest

Like pregnancy, the newborn period can be a time of excitement, joy, and exhaustion. You may look at your wondrous little baby and feel happy. You may also be overwhelmed by your new sleep hours and new responsibilities.
Make time to rest.

Rest every day. Try to nap when your baby
naps. Stay flexible so you can eat at odd hours and sleep when
you need to.

Ask another adult to be with you for a few days after
delivery.

Plan for child care if you have other
children.

Plan
small trips to get out of the house. Change can make you feel less
tired.

Ask for help with housework, cooking, and shopping. Remind
yourself that your job is to care for your baby.

Sexuality, fertility, and birth control

Your body needs time to heal after childbirth. This can take about 4 to 6 weeks, but it's different for each woman. Avoid
sexual intercourse and putting anything in your vagina (including tampons) until
you have stopped bleeding. Your doctor will let you when it's okay to have intercourse.

Your
menstrual cycle-and your ability to become pregnant again-will return at
your body's own pace. Remember that you can
ovulate and get pregnant during the month
before your first menstrual period, as early as 3 weeks after childbirth. If you don't want to become pregnant right away,
use birth control even if you are breast-feeding.

If you don't breast-feed, your menstrual
periods may begin within a month or two after delivery.

If you
breast-feed full-time, your periods will probably not resume for a few months.
The average among women who breast-feed exclusively is 8 months. But
breast-feeding is not a dependable method of birth control. For more
information, see
Breast-Feeding as Birth Control.

Most methods of birth control are safe and effective after delivery. But in the first couple of weeks after delivery or if you are breast-feeding, it's best to use a method that doesn't contain estrogen. Talk to your doctor about which type is
best for you. For more information, see the topic
Birth Control.

Healthy eating

Eating a variety of healthy food is important to help you keep your energy and lose extra weight you gained during your pregnancy. Eat healthy foods so you have more energy, make
good breast milk, and lose extra baby pounds.

Eat a variety of foods to help you get all the nutrients you need. Your body needs protein, carbohydrate, and fats for energy.

Eat a diet high in fiber. Include foods such as whole-grain breads and cereals, raw vegetables, raw and dried fruits, and beans.

Drink plenty of fluids, especially water.

Eat small snacks throughout the day to keep up your energy. Don't skip meals or go for long periods without eating.

Exercise

Exercise helps you feel good and helps your body get back to its prepregnancy shape. In general, you can start exercising 4 to 6 weeks after delivery. But check with your doctor before you start exercising, especially if you had a cesarean birth (C-section).

Start daily exercise after 4 to 6 weeks, but rest
when you feel tired.

Newborn Basics

During your baby's first few weeks, you will spend most of your
time feeding, diapering, and comforting your baby. You may feel overwhelmed at
times. It is normal to wonder if you know what you're doing, especially if this is your first child. Newborn care gets easier with every day. You may get to know what each cry means and be able to figure out what your baby needs and
wants.

Feeding

Breast-feeding is a
learned skill-you will get better at it with practice. You may have times when
breast-feeding is hard. The first two weeks are the hardest for many women. But don't give up. You can work through most problems. Doctors, nurses, and
lactation specialists can all help. So can friends,
family, and breast-feeding support groups.

Some women choose to feed their babies using formula. While breast milk is the
ideal food for babies, your baby can get good nutrition from formula.

Sleeping

Most babies sleep for a total of 18 hours each day. They
wake for a short time at least every 2 to 3 hours. Always put your baby to sleep on his or her
back, not the stomach. This lowers the risk of sudden infant death syndrome
(SIDS).

You have severe vaginal bleeding. You are passing blood clots and
soaking through a pad each hour for 2 or more hours.

Your vaginal bleeding seems to be getting heavier or is still
bright red 4 days after delivery, or you pass blood clots larger than the size
of a golf ball.

You are dizzy or lightheaded, or you feel like you may
faint.

You are vomiting or cannot keep fluids down.

You have a fever.

You have new or more belly pain.

Your breast or breasts have hard, red, or tender
areas.

You have an urgent or frequent need to urinate, along with a
burning feeling.

You have severe pain, tenderness, or swelling in
your vagina or the area between your rectum and vagina.

You have
severe pains in your chest, belly, back, or legs.

You have
feelings of severe despair or great anxiety.

References

Other Works Consulted

Centers for Disease Control and Prevention (2011). Update to CDC's U.S. medical eligibility criteria for contraceptive use, 2010: Revised recommendations for the use of contraceptive methods during the postpartum period. MMWR, 60(26): 878-883. Available online: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6026a3.htm?s_cid=mm6026a3_w.

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